Haematology User Guide - Central Manchester University Hospitals
Contents
1. Symptomatic inherited thrombophilia 2 5 Anti Phospholipid syndrome 2 5 Non rheumatic atrial fibrillation 2 5 Atrial fibrillation due to rheumatic heart disease 2 5 Congenital heart disease 2 5 Cardioversion 2 5 Mural thrombus 2 5 Cardiomyopathy 2 5 Mechanical prosthetic heart valve 3 5 Authorised by Neil Laurie Page 7 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Haemolytic Disorders Screening involves a blood count amp film reticulocyte count direct antiglobulin Coombs test and serum haptoglobins Haematology and serum bilirubin Chemical Pathology Other tests should be discussed with the Consultant Haematologist Haemoglobinopathies A screen requires two EDTA Red specimens Test Quantity Tube Type Ref Ranges Stability Turnaround 2 F 8 C Times Sickle Cell Screen 2 7 ml 1 x red including EDTA 1 week 3 working days required can Hb Variant amp Thal be shared aassacma with FBC Screening Hb A2 1 5 3 2 Hb F lt 1 Serum Ferritin Plain brown 10 186 ng ml Female 30 284 ng ml 1 week 1 working day Male A low MCV is common in iron deficiency and thalassaemia Beta thalassaemia traits a2. Haematology User Guide Version 7 Referred Work Although the majority of samples are processed in the laboratory at Trafford some less frequently requested or highly specialised tests are referred to other hospitals All referral laboratories are full CPA accredited and reports of these tests state the referral laboratory used The most commonly used laboratories are Molecular Diagnostics Centre Department of Haematology Cytogenetics Department Manchester Royal Infirmary Manchester Royal Infirmary St Mary s Hospital Manchester Manchester Hathersage Road M13 9SWL M13 9SWL Manchester M13 OJH Oncology Cytogenetics Haemostasis Laboratory Christie Hospital Specialist Haematology Wilmslow Road Block 32 Manchester St James s University Hospital M20 4BX Beckett Street Leeds LS9 7TF Authorised by Neil Laurie Page 12 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Quality Assurance Programmes As part of our on going commitment to Quality and service improvement we participate in all appropriate National External Quality Assurance schemes for Haematology Internal Quality Control Comprehensive internal quality control procedures are followed in Haematology covering all aspects of work
3. CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 All Pathology specimens and request forms MUST be transported in bags identified with the Biohazard logo Specimen containers and transport bags must be securely sealed Each request form should include sufficient clinical information to enable laboratory personnel to adopt additional safety precautions should they be required Any specimen sent from a patient with known or suspected HIV Hepatitis B or C must have a yellow INOCULATION RISK label affixed clearly to both the specimen container and request form Patients who have developed a fever within 21 days of having returned form Africa or other countries where Lassa Fever or other Viral Haemorrhagic Fevers occur or who through their work may have had contact with any of these viruses should be discussed with the department in Pathology before the collection or transport of specimens to establish a need for any special containment The majority of requests require no more than 7 5 ml of blood However some tests may vary For general enquiries please phone extension 2492 3 Pneumatic Air Tube Transport System The following blood specimens must not be sent via the air tube e any specimen from patients know to have or thought to have transmissible spongiform encephalopathy CJD GSS etc a viral haemorrhagic fever eg Lassa Ebola etc Specimen Carriers Som
4. Secretary 0161 746 2470 Dr Patrick A Carrington Consultant Haematologist 0161 746 2490 Mrs Ann Winstanley Secretary 0161 746 2855 Mr Neil Laurie Head Biomedical Scientist 0161 746 2491 Laboratory 0161 746 2493 Out of hours bleep number 060 Anticoagulant Service Sr Freda Sharpen 0161 746 2496 or bleep 102 Sr Karen Underwood S N Ann Wright Haematology Clinics TGH Mon am Thurs pm Fri am Anticoagulant AGH Wed am Clinics are nurse led although a Haematologist is available TGH Dr D M Alderson Tues am General Haematology TGH Dr P A Carrington Mon pm AGH Dr D M Alderson or Dr Carrington Thurs am TGH Dr D M Alderson Wed am TGH Dr P A Carrington Wed am Haematology Oncology Authorised by Neil Laurie Page 2 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Request Forms There is a combined Hospital Haematology Chemistry request form for hand written in patient requests and a combined GP request form containing Chemistry Haematology and Microbiology Electronic requesting should be used where available The patient s full name and date of birth must be clearly visible and legible on both request form and specimen Identification Cri
5. below Thrombin Time To mark Green 7 7 10 5 seconds 4 hours 4 hours exactly citrate Fibrinogen Assay To mark Green 1 7 4 0 g l 4 hours 4 hours exactly citrate Authorised by Neil Laurie Page 6 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 D Dimer To mark Green lt 500 ug l 4 hours 4 hours exactly citrate Lupus To mark Green x 4 4 hours 2 weeks Anticoagulant exactly citrate Thrombophilia To mark Green x 6 4 hours 2 4 weeks Screen Protein exactly citrate sent to referral C amp S ATIII amp laboratory APCR Factor Assays Contact Consultant Haematologist Please note that under filled samples cannot be tested Patients taking Oral Anticoagulants These should be monitored by the international normalised ratio INR The therapeutic level 2 0 4 5 depends upon condition treated An INR of within 0 5 units of target is generally satisfactory Indication Target INR Pulmonary Embolus 2 5 Proximal Deep Vein Thrombosis 2 5 Calf Vein Thrombosis 2 5 Recurrence of Venous Thrombo embolism when no longer on Warfarin therapy o Recurrence of venous thrombo embolism whilst on Warfarin therapy 3 5
6. 84 ng ml Male Authorised by Neil Laurie Page 9 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Miscellaneous Tests Test Quantity Tube Ref Ranges Stability Turnaround Type Adult times 24hrs if whole blood used Tred Plasma or Glandular Fever EDTA can serum can be creenin 7m negative ridged at 2 working da EBV S ing 2 7 ml b amp shared gati fridged at 2 1 king day Test with FBC 8 C for 48 hours or frozen at 20 C for longer periods Haptoglobi 7 5 ml Elan 045 1999 2 working d aptoglobin 5m 45 1 working days prog Brown 9 2 8 C g aay EPO stability from venepuncture 0 8 hrs at room temp air tight container cell 2 weeks free sample sent to Serum Plain sa Erythropoeitin 7 5 ml Brown 2 20 mu ml 8 24 hrs at 2 specialised 8 C air tight centre container cell free sample Over 24hrs frozen sample at 20 C Plasma must be separated 2 weeks Plasma 0 0 16 0 from cells sent to Homocysteine ZREDTA EO DA ERR umol l within 1 hour of AR collection centre before freezing Factor V Leiden enetic test holies ae A ml Citrate 1 w 2 weeks Prothrombin Gene 2 e grisen 2 8 C sent to Variant G20210A specialised cent
7. CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Haematology User Guide Location of Haematology Department c cessseeeeeeeeseeeeeeeeeeeees 2 Opening HOUS orcs raain recs aati tesa anaa a aneao Ee aaaea EEE anaE Ein 2 Haematology Clinics ssssssasssnnennnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nnne 2 FRREGUCSE FOM S icc iscsecsceancis tore acsaetedat tee enaa Danka aun sa irana An r anaa aLa 3 Identification Criteriavxcnciviciiniisninnnnminnnninmnon 3 Collection and Transportation of Specimens sseeeeeeeeeeeeeees 3 R tine Servicer A E aar aSa aE a ANE kinase E SEERE EEEE eA POENE ra aE Sii 4 Routine Investigations ccccccceeeeeeeeeeeeeeeeeeeeeeeeeeeeseeeneeseeeeeeseeeeeeees 5 Full Blood Count FBC including Automated Differential Leucocyte COUN sshedea2 aeesevacatansvactendsa sestansadcdduda cestas tfoaedudus A feaagecssbes 5 Erythrocyte Sedimentation Rate ESR ccccceessseeeeeeeeeaeeeeeeeees 6 COaGg lat OM iia oe cect inate aaedancice eda rata licens divesbaacedenden lease a T 6 Coagulation Tests Available c ccccccccssssseeeeeceeeseeeeeseaeeeeeeeeseeees 6 Patients taking Oral Anticoagulant ccccceceeesseeeeeeeeaeeeeeeeeseeees 7 Haemolytic Disorders siciscsscvssestecensssct cesneectinncetentn earnest eiiereaeteeietes 8 Haemoglobinopathies cccccccssesccecseseecnseececeeeee
8. ays 4 hours Basophils 0 0 1 x 107 L 2 days 4 hours Authorised by Neil Laurie Page 5 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Erythrocyte Sedimentation Rate ESR 2 7ml blood EDTA Red tube required The sample bottle MUST be correctly and fully filled to the top line with the plunger pulled to the bottom of the tube Under filled tubes may be rejected as insufficient for ESR testing Reference ranges Stability Turnaround times RT Male age 17 50 0 10 mm hr 51 60 0 12 mm hr 61 70 0 14 mm hr 71 0 30 mm hr 6 hours 4 hours Female age 17 50 0 12 mm hr 51 60 0 19 mm hr 61 70 0 20 mm hr 71 0 35 mm hr Coagulation Suspected Bleeding Diathesis Take a full history of present and past bleeding incidents and enquire about family history and drug ingestion Coagulation Tests Available Test Quantity Tube Ref Range Stability Turnaround Type RT Times Prothrombin To mark Green 10 3 12 5 8 hours 4 hours Time PT exactly citrate Seeunigs APTT To mark Green 21 4 29 3 8 hours 4 hours exactly seconds citrate INR To mark Green See guidelines 8 hours 4 hours exactly citrate
9. e areas of the hospital are served by porters who will carry samples to the laboratory but where this service is not available it is essential that anyone carrying samples to the laboratory does so in accordance with the published laboratory guidelines P04 005 F5 Guidelines for laboratory porters and messengers including all staff carrying or handling samples for the laboratory Specific laboratory containers sealed red boxes are provided for the safe transport of specimens to the laboratory from within the hospital so samples must not be carried in the hand or in a pocket Pathology and or PCT transport services will collect samples from the PCT and other local hospitals on a daily basis Routine service Most results are available on the day of receipt of sample in the laboratory Urgent service The majority of urgent samples will be analysed within one hour of receipt in the laboratory This includes e FBC including WBC differential e Clotting tests PT INR APTT D Dimer Thrombin time amp Plasma Fibrinogen Authorised by Neil Laurie Page 4 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Processing of other urgent tests will commence within an hour of receipt but results ma
10. in the laboratory References Title Source Safe Working and the prevention of infection in Health Services Advisory Committee Clinical laboratories and similar facilities 2003 Disinfection decontamination and biological Pathology management procedure spillage procedure Pathology Quality Manual Trafford Healthcare NHS Trust A Practical Guide to Accreditation in Laboratory David Burnett Medicine Standards for the Medical Laboratory Clinical Pathology Accreditation UK Ltd Authorised by Neil Laurie Page 13 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible
11. re HFE gene typing 1 week 2 weeks Haemachromatosis 2 x EDTA EDTA red Sentito C282Y H63D 2 8 C Geno specialised centre Must arrive in i Chromosome 5 10 mi Heparin ae a 7 working Studies Man i laboratory within 48 hours Routine 28 Authorised by Neil Laurie provided they are current versions may be retained for use where Q Pulse is inaccessible Page 10 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies CMFT Trafford Hospitals Division Department of Pathology Haematology User Guide Document 115 Version 7 paediatrics of collection working days 1 6 weeks 2 x EDTA 1 week depending on Other DNA tests 1ml if EDTA red o the nature and paediatric 2 8 C complexity of the tests accompanied by appropriate request forms available from the laboratory Other Haematologist specialised Tests by arrangement with the laboratory or Consultant All quoted turnaround times are approximate and are timed from receipt in the laboratory in either hours or working days working weeks for sendaway tests Authorised by Neil Laurie Page 11 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115
12. re usually not anaemic but characteristically show a raised HbA2 gt 3 5 and normal ferritin Malarial Parasites A fresh EDTA samples is required less than four hours old All requests for malaria should give details of the country visited if West Central Africa date of return to UK and date of onset of symptoms are required Requests without this information cannot be processed until this is obtained due to potential risk to staff handling samples A blood count will be performed routinely with each request Sunquest ICE users please follow on screen instructions and complete the risk assessment Stability 4 hours Turnaround time 4 hours Authorised by Neil Laurie Page 8 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Haematinic Assays The following tests are available Serum Vitamin B12 Serum Folate amp Serum Ferritin Test Quantity Tube Type Ref Range Stability Turnaround 2 8 C times Serum B12 and 7 5 ml One plain B12 gt 183 pg ml 1 week 1 working day Folate brown tube Folate 4 6 18 7 required ng ml Serum Ferritin 7 5 ml Plain brown 10 186 ng ml 1 week 1 working day only Female required if B42 also required 30 2
13. sseseeeeneeeeesnesseeenees 8 Malarial Parasites sc sicu ccnasccsessace naira iiiaae 8 Ha Matinic ASSAYS issc i ossccactaccadas censccewesbantens xeotesznceadacieostianoneeiiees 9 Miscellaneous TeSts ccccceeeeeeeeeeeeeeeeeeeeeeeeeeeeeneessaaseeeeeeseessaenees 10 Referred VV OE arara aeara tirera da deara bi vias etasaeantens vente eecscteieaauetahe 12 Quality Assurance Programmes ccccssseeeeeeeeeeeeeeeeeeeneeeneeeneneees 13 EEEIEI D o 1 PEA E EEE E E ateden nce auccndsedeeaautetts 13 Authorised by Neil Laurie Page 1 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible CMFT Trafford Hospitals Division Department of Pathology Document 115 Haematology User Guide Version 7 Location of Haematology Department The department is situated on the lower floor of the Pathology Building at the rear of the Hospital Specimen Reception is on the lower reception floor clearly signposted behind the patient reception desk All samples delivered out of the routine opening hours below must be placed in the refrigerator besides the specimen reception window Opening Hours TGH 8 45am 5 00pm Mon Fri TGH 8 45am 12 30pm Sat Biomedical Scientist on call at all other times Bleep 060 through hospital switchboard Dr David M Alderson Consultant Haematologist 0161 746 2472 Ms Judith Massey
14. teria Essential Desirable Sample Patients full name or correctly coded Time sample taken sometimes essential identification Hospital or NHS Number Date of Birth Date collected Request Patients full name or correctly coded Clinicians bleep No Form Idenuificauon Signature of requesting Clinician Date of birth Sex of patient Patients address Clinical details Report destination Time collected Requesting Consultant or GP including computer code Requesting Clinician Date collected Electronic record or NHS number The doctor s name and report destination must be clearly printed to allow reports to be returned to the appropriate location Specimens must be placed into the attached bag and sealed correctly Please see the Pathology Sample Acceptance Criteria for further details Collection and Transportation of specimens The Monovette blood collection system comprising a combined syringe container and a needle with valve for multiple samples is used If difficulties are experienced contact the laboratory Sharing of samples with other departments is not acceptable and may result in samples not being analysed for all tests Labelling for Danger of Infection Authorised by Neil Laurie Page 3 of 13 The master copy of the current version of this document is held in Q Pulse Printed copies provided they are current versions may be retained for use where Q Pulse is inaccessible
15. y take up to two hours This includes e ESR and Screen for Malarial Parasites e Haematinic requests will be analysed the next working day Routine Investigations Full Blood Count FBC including Automated Differential Leucocyte Count 2 7 ml blood EDTA Red tube required minimum volume required is approximately 0 5ml Analysis includes Hb PCV MCV MCH MCHC platelets WBC and WBC differential Haematology analysers provide highly accurate automated differential counts for all five leucocyte populations Blood films will normally be made at the discretion of the laboratory staff and or Consultant Haematologist Stability Turnaround time Test Reference Range Adult a 2 8 C RBC Male 4 46 5 54 x 107 L 2 days 4 hours Female 3 87 5 51 x 107 L Haemoglobin Male 120 175 g L 2 days 4 hours Female 115 165 g L Elderly 125 169 g L Haematocrit Male 40 54 2 days 4 hours Female 37 417 MCV 80 98 fL 2 days 4 hours MCH 27 0 34 0 pg 2 days 4 hours MCHC 310 360 g L 2 days 4 hours RDW 11 8 14 8 2 days 4 hours WBC 3 5 11 0 x 107 L 2 days 4 hours Platelets 130 450 x 10 7 L 2 days 4 hours Reticulocytes 21 81 x 107L 2 days 4 hours MPV 7 1 10 7 fL 2 days 4 hours Neutrophils 1 7 7 9 x 107 L 2 days 4 hours Lymphocytes 1 0 4 0 x 10 L 2 days 4 hours Monocytes 0 2 0 8 x 107L 2 days 4 hours Eosinophils 0 04 0 4 x 107 L 2 d
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